Pneumonitis after normofractionated radioimmunotherapy: a method for dosimetric evaluation
Abstract Background Post-Therapy-Pneumonitis (PTP) is a critical side effect of both, thoracic radio(chemo)therapy (R(C)T) and immune checkpoint inhibition (ICI). However, disease characteristics and patient-specific risk factors of PTP after combined R(C)T + ICI are less understood. Given that RT-t...
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BMC
2024-11-01
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| Series: | Radiation Oncology |
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| Online Access: | https://doi.org/10.1186/s13014-024-02561-z |
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| author | Kim Melanie Kraus Caroline Bauer Lisa Steinhelfer Benedikt Feuerecker Juliana Cristina Martins Julius Clemens Fischer Kai Joachim Borm Jan Caspar Peeken Denise Bernhardt Stephanie Elisabeth Combs |
| author_facet | Kim Melanie Kraus Caroline Bauer Lisa Steinhelfer Benedikt Feuerecker Juliana Cristina Martins Julius Clemens Fischer Kai Joachim Borm Jan Caspar Peeken Denise Bernhardt Stephanie Elisabeth Combs |
| author_sort | Kim Melanie Kraus |
| collection | DOAJ |
| description | Abstract Background Post-Therapy-Pneumonitis (PTP) is a critical side effect of both, thoracic radio(chemo)therapy (R(C)T) and immune checkpoint inhibition (ICI). However, disease characteristics and patient-specific risk factors of PTP after combined R(C)T + ICI are less understood. Given that RT-triggered PTP is strongly dependent on the volume and dose of RT [1], driven by inflammatory mechanisms, we hypothesize that combination therapy of R(C)T with ICI influences the dose-volume-effect correlation for PTP. This study focuses on the development of a method for evaluation of alterations of dosimetric parameters for PTP after R(C)T with and without ICI. Methods and materials PTP volumes were delineated on the follow-up diagnostic Computed Tomography (CT) and deformably matched to the planning CT for patients with PTP after thoracic R(C)T + ICI or R(C)T. Dose data was converted to 2-Gy equivalent doses (EQD2) and dosimetrically analyzed. Dosimetric and volumetric parameters of the segmented PTP volumes were analyzed. The method was exemplarily tested on an internal patient cohort including 90 patients having received thoracic R(C)T + ICI (39) and R(C)T (51). Thirtytwo patients with PTP were identified for further analysis. Additional data on previous chemotherapy, RT, smoking status and pulmonary co-morbidity were conducted. A matched pair analysis with regard to planning target volumes (PTV) was conducted for curative intended (definitive) and palliative patient cohorts individually. Results The presented method was able to quantify and compare the dosimetric parameters of PTP for the different therapies. For our study group, no significant differences between R(C)T + ICI and R(C)T only was observed. However, the dosimetric analysis revealed large volumetric fractions (55%) of the PTP volumes to be located outside of high dose (EQD2 < 40 Gy) regions for R(C)T + ICI. There was a non-significant trend towards increased area under the curve of the dose volume histogram (AUC) values for R(C)T + ICI compared to R(C)T only (3743.6 Gy∙% vs. 2848.8 Gy∙%; p-value = 0.171). In contrast to the data for the palliative intended treatment group, for definitive R(C)T + ICI, data tended towards increased volumes with higher doses. Conclusions The proposed method was capable to quantify dosimetric differences in the dose-volume-effect relationship of PTP for patients with R(C)T + ICI and patients with R(C)T only. In this exploratory analysis, no significant dosimetric differences within PTP volumes for the different groups could be observed. However, our observations suggest, that for safe application of thoracic R(C)T + ICI, further careful investigation of dosimetric prescription and analysis concepts with larger and conformer study groups is recommendable. |
| format | Article |
| id | doaj-art-e64615a0db2143bfb628ea57380638a2 |
| institution | OA Journals |
| issn | 1748-717X |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
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| series | Radiation Oncology |
| spelling | doaj-art-e64615a0db2143bfb628ea57380638a22025-08-20T02:22:24ZengBMCRadiation Oncology1748-717X2024-11-0119111010.1186/s13014-024-02561-zPneumonitis after normofractionated radioimmunotherapy: a method for dosimetric evaluationKim Melanie Kraus0Caroline Bauer1Lisa Steinhelfer2Benedikt Feuerecker3Juliana Cristina Martins4Julius Clemens Fischer5Kai Joachim Borm6Jan Caspar Peeken7Denise Bernhardt8Stephanie Elisabeth Combs9Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM)Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM)Department of Radiology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich (TUM)Partner Site Munich, German Consortium for Translational Cancer Research (DKTK)Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM)Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM)Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM)Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM)Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM)Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM)Abstract Background Post-Therapy-Pneumonitis (PTP) is a critical side effect of both, thoracic radio(chemo)therapy (R(C)T) and immune checkpoint inhibition (ICI). However, disease characteristics and patient-specific risk factors of PTP after combined R(C)T + ICI are less understood. Given that RT-triggered PTP is strongly dependent on the volume and dose of RT [1], driven by inflammatory mechanisms, we hypothesize that combination therapy of R(C)T with ICI influences the dose-volume-effect correlation for PTP. This study focuses on the development of a method for evaluation of alterations of dosimetric parameters for PTP after R(C)T with and without ICI. Methods and materials PTP volumes were delineated on the follow-up diagnostic Computed Tomography (CT) and deformably matched to the planning CT for patients with PTP after thoracic R(C)T + ICI or R(C)T. Dose data was converted to 2-Gy equivalent doses (EQD2) and dosimetrically analyzed. Dosimetric and volumetric parameters of the segmented PTP volumes were analyzed. The method was exemplarily tested on an internal patient cohort including 90 patients having received thoracic R(C)T + ICI (39) and R(C)T (51). Thirtytwo patients with PTP were identified for further analysis. Additional data on previous chemotherapy, RT, smoking status and pulmonary co-morbidity were conducted. A matched pair analysis with regard to planning target volumes (PTV) was conducted for curative intended (definitive) and palliative patient cohorts individually. Results The presented method was able to quantify and compare the dosimetric parameters of PTP for the different therapies. For our study group, no significant differences between R(C)T + ICI and R(C)T only was observed. However, the dosimetric analysis revealed large volumetric fractions (55%) of the PTP volumes to be located outside of high dose (EQD2 < 40 Gy) regions for R(C)T + ICI. There was a non-significant trend towards increased area under the curve of the dose volume histogram (AUC) values for R(C)T + ICI compared to R(C)T only (3743.6 Gy∙% vs. 2848.8 Gy∙%; p-value = 0.171). In contrast to the data for the palliative intended treatment group, for definitive R(C)T + ICI, data tended towards increased volumes with higher doses. Conclusions The proposed method was capable to quantify dosimetric differences in the dose-volume-effect relationship of PTP for patients with R(C)T + ICI and patients with R(C)T only. In this exploratory analysis, no significant dosimetric differences within PTP volumes for the different groups could be observed. However, our observations suggest, that for safe application of thoracic R(C)T + ICI, further careful investigation of dosimetric prescription and analysis concepts with larger and conformer study groups is recommendable.https://doi.org/10.1186/s13014-024-02561-zImmunotherapyRadioimmunotherapyRadiation pneumonitisLung cancerImmune checkpoint inhibitionDose volume histogram |
| spellingShingle | Kim Melanie Kraus Caroline Bauer Lisa Steinhelfer Benedikt Feuerecker Juliana Cristina Martins Julius Clemens Fischer Kai Joachim Borm Jan Caspar Peeken Denise Bernhardt Stephanie Elisabeth Combs Pneumonitis after normofractionated radioimmunotherapy: a method for dosimetric evaluation Radiation Oncology Immunotherapy Radioimmunotherapy Radiation pneumonitis Lung cancer Immune checkpoint inhibition Dose volume histogram |
| title | Pneumonitis after normofractionated radioimmunotherapy: a method for dosimetric evaluation |
| title_full | Pneumonitis after normofractionated radioimmunotherapy: a method for dosimetric evaluation |
| title_fullStr | Pneumonitis after normofractionated radioimmunotherapy: a method for dosimetric evaluation |
| title_full_unstemmed | Pneumonitis after normofractionated radioimmunotherapy: a method for dosimetric evaluation |
| title_short | Pneumonitis after normofractionated radioimmunotherapy: a method for dosimetric evaluation |
| title_sort | pneumonitis after normofractionated radioimmunotherapy a method for dosimetric evaluation |
| topic | Immunotherapy Radioimmunotherapy Radiation pneumonitis Lung cancer Immune checkpoint inhibition Dose volume histogram |
| url | https://doi.org/10.1186/s13014-024-02561-z |
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